Dental caries, commonly known as cavities or tooth decay, are one of the most prevalent dental conditions affecting people worldwide. Left undetected and untreated, they can cause pain, tooth loss and even systemic infections. Early detection and treatment is key to preventing the progression of dental caries.

Traditional Visual Examination

For many years, the traditional method of checking for dental caries has involved visual examination by the dentist using dental mirrors and probes under adequate lighting. The dentist looks for any changes in the colour, texture or structure of the tooth surface that may indicate demineralization or decay. Though effective when lesions are visible on the outer tooth surfaces, this method has its limitations as early-stage interproximal or smooth surface caries may not always be apparent visually. Moreover, visually detecting caries in children's developing dentition can be challenging.

Newer Detection Technologies

To overcome the drawbacks of visual examination alone, dentists are now making use of newer detection aids and technologies that can help identify Dental caries Detectors at their very early, non-cavitated stage before they are visible to the naked eye. Some of the commonly used advanced caries detection methods are:

Bitewing X-Rays

Dental bitewing X-rays provide a view of interdental and interproximal tooth regions that are difficult to assess visually. They allow detection of demineralization between teeth before a cavity forms. Digital radiography provides high-quality images and lower radiation dose compared to conventional films. However, X-rays expose patients to radiation and may not be suitable for frequent or routine screening.

Laser and LED Diagnostic Devices

Lasers like diode lasers and quantitative light-induced fluorescence (QLF) utilize specific wavelengths of light that get absorbed by the porphyrins within demineralized tooth structure. This enables identification of caries at an enamel level, sometimes even before they appear on radiographs. Devices like laser fluorescence use lasers, while others use LED technology for caries detection. They provide early diagnosis but cost more than conventional methods.

Electrical Conductivity Testing

Electrical caries detectors measure the electrical conductance or resistance of tooth structure. Healthy enamel and dentin have high resistance that reduced as they demineralize during the caries process. Devices like the DIAGNOdent pen work on this principle to detect demineralization in its initial stages with good accuracy. They are simple to use chairside but cannot localize or assess lesion depth like radiographs.

Smartphone-Based Detectors

In recent years, caries detection technology is increasingly making use of smartphone cameras and apps. Devices that attach to smartphones use fluorescence, transillumination or difference contrast imaging techniques to detect signs of demineralization. Some apps even analyse still images clicked through smartphone cameras using artificial intelligence algorithms. These affordable methods hold promise but require more validation through long-term studies.

Diagnostic Accuracy Comparison Studies

Several clinical studies have evaluated and compared the diagnostic accuracy of various caries detection methods - be they conventional like visual/tactile examination or bitewing radiographs or the newer methods discussed above. In general, technologies using laser fluorescence, electrical conductance testing and digital radiography have been found to perform better than visual inspection alone for early interproximal caries diagnosis, with higher accuracy levels ranging from 70-95%. However, no single method has proved consistently superior, and the choice often depends on specific patient and clinical factors. Combining examination methods appears most effective for comprehensive caries diagnosis and risk assessment.

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